CONGENITAL

MASSES &
MALFORMATIONS

Cummings Otolaryngology 6th

ed
RULE IN IF:
 gradual dyspnea, dysphagia and stridor
 recurrent respiratory obstruction
 visible and palpable neck mass
 TYPES OF CONGENITAL MASSES
AND MALFORMATIONS
 BRANCHIAL CLEFT CYST
 nontender, fluctuant masses
that may become inflamed
and form an abscess
during an upper respiratory
infection
 Ultrasound : fluid filled cyst
 THYROGLOSSAL DUCT CYST
 Asymptomatic midline mass that
elevates with swallowing or
tongue protrusion
 Thyroid ultrasound and
radionucleotide scanning to
differentiate it from ectopic thyroid
(with hypothyroidism)
 TYPES OF CONGENITAL MASSES
AND MALFORMATIONS
 LYMPHANGIOMAS
 failure of lymph spaces to connect to
the rest of the lymphatic system
 soft, smooth, nontender mass that is
compressible and that can be
transilluminated
 Radiography shows fluid-flled spaces
with surrounding connective tissue.
 Infiltrative, needs complete surgical
excision
 HEMANGIOMAS
 proliferative endothelial lesions rather than
true neoplasms
 slowly involute at 18 to 24 months
 red or bluish soft masses that frequently
have a cutaneous component
 CT or MRI with contrast often confirms the
diagnosis of a vascular lesion
 airway obstruction at subglottic larynx
 Observation unless develop complication
treat with systemic corticosteroids and
surgical excision
 TYPES OF CONGENITAL MASSES
AND MALFORMATIONS
 TERATOMAS  DERMOID CYST
 arise from pluripotent cells and  arise from epithelium that has been
consist of tissues foreign to the site entrapped in tissue during
from which they arise embryogenesis or by traumatic
implantation
 firm neck masses
 consist of epithelium-lined cavities
 Tracheal compression may be
filled with skin appendages such as
present hair, hair follicles, and sebaceous
 Intrinsic calcifications seen on CT glands
or MRI  painless unless infected
 Surgical excision
 TYPES OF CONGENITAL MASSES
AND MALFORMATIONS
 LARYNGOCELES
 abnormal dilation or herniation of
the
saccule of the larynx
 @ thyroid cartilage – internal; @
beyond thyroid cartilage – external
 Hoarseness, cough, dyspnea, and
dysphagia suggest a laryngocele
 THYMIC CYST
 Almost all are unilateral, most
commonly on the left side of the
neck, and 90% are cystic
 asymptomatic mass, but it may be
painful if infected, or if the size
increase is rapid
 TYPES OF CONGENITAL MASSES
AND MALFORMATIONS
 VASCULAR MALFORMATIONS
 Slow-flow lesions include capillary
malformations and venous
malformations, arterial and
arteriovenous malformations are
typically fast-flow lesions
 grow at the same rate as the child and
do not involute
 Jugular malformations present as soft,
compressible masses along the anterior
border of the sternocleidomastoid
muscle.
 STERNOCLEIDOMASTOID TUMOR
IN INFANCY
 Congenital torticollis
 firm, painless, discrete, fusiform mass
within the sternocleidomastoid muscle
 usually not apparent at birth but
appear at 1 to 8 weeks of age
 Slowly increase in size for 2 to 3
months and then slowly regress for 4
to 8 months
• RULE OUT since the case is
• a single incident of foreign body aspiration with atis seed
• sudden onset of dyspnea and cyanosis,
• relieved by back tapping
• NO visible and palpable neck mass
• Chest Xray shows that the obstruction is at the lower
part of respiratory tract (Bronchus)